Covid-19 and beyond: What South Africans need to know about respiratory illnesses today

10 Jan 2025

If you’ve been hit with a respiratory tract infection this festive season, it’s more likely to be Covid-19 than the flu. However, experts and officials say there’s no cause for alarm, as the circulation and severity of the virus remains low.

Five years on from the outbreak of the Covid-19 pandemic, many of the hallmarks of the health crisis have all but disappeared — face masks, social distancing markings, hand sanitising stations. However, SARS-CoV-2 — the virus that causes Covid-19 — continues to circulate at low levels, with minor fluctuations.

With the new year under way, Daily Maverick looked into current trends around respiratory viruses locally and in the international community, including claims about a rise in Covid-19 infections and concerns related to an outbreak of human metapneumovirus (hMPV) in China.

Have Covid-19 cases been on the rise this summer?

In the National Institute for Communicable Diseases’ Weekly Respiratory Pathogens Surveillance Report, based on data collected up to 29 December 2024, it was stated that SARS-CoV-2 continued to “circulate at low levels with fluctuations”.

“There have been small increases in detections over the recent weeks, but not very different from fluctuations seen throughout the year,” noted the report.

Dr Ridhwaan Suliman, principal researcher at the Council for Scientific and Industrial Research (CSIR), told Daily Maverick that the Covid-19 infection rate in South Africa began to rise around October 2024 — a trend that was picked up by the National Institute for Communicable Diseases’ SARS-CoV-2 Wastewater Surveillance project.

The project allows the institute to monitor the levels of SARS-CoV-2 infections across South Africa by measuring virus concentrations in community wastewater.

“The levels (of Covid-19) have risen to the highest observed over the past year. South Africa has been experiencing these waves of SARS-CoV-2 over the summer months since the emergence of the virus in 2020, where each summer has brought about a wave of Covid-19 infections, while influenza has been mostly prevalent during the winter months,” said Suliman.

The institute also runs a sentinel surveillance programme for Covid-19 in all provinces, which involves the systematic testing of patients with respiratory illness for SARS-CoV-2 and other respiratory viruses at representative facilities, according to Professor Cheryl Cohen, head of the Centre for Respiratory Diseases and Meningitis at the institute.

“The data from sentinel surveillance in all provinces of South Africa shows that SARS-CoV-2 continues to circulate at low levels. There has not been any increase observed in recent weeks… The systematic approach is important because it reduces any bias introduced by changes in the testing practices of clinicians,” said Cohen.

Is the current Covid-19 infection rate a cause for concern?

No, it’s not.

According to Suliman, there is no reason for the public to be alarmed or to react any differently to Covid-19 than they would to the flu.

“Due to high levels of immunity now against SARS-CoV-2, as well as an improved understanding of the virus and better treatment approaches and protocols, the severity of the virus remains low. If one does come down with Covid-19, the same approaches to the normal flu apply — get lots of rest and supplement with vitamins,” he said.

Foster Mohale, the spokesperson for the national Department of Health, said there had been no rise in Covid-19 cases in the country, “despite fallacious social media posts which suggest otherwise”.

“(There’s) no need for the public to panic, they should ignore this spreading report. The department (is) working with the National Institute for Communicable Diseases conducting ongoing surveillance for early detection cases or outbreaks for rapid response,” he said.

Has there been a notable rise of any other respiratory infections in SA?

There has been no spike in cases of respiratory illnesses in South Africa, according to Mohale. However, he urged people to observe personal hygiene practices at all times to protect themselves and their loved ones.

The National Institute for Communicable Diseases detected no cases of influenza or respiratory syncytial virus in the country between 23 and 29 December 2024. In the month of December, it detected eight cases of Bordetella pertussis, the bacterium that causes whooping cough.

Suliman said: “It should be noted that the influenza season in South Africa is during our winter months and therefore ended months ago. Anyone presenting with flu-like symptoms during this period is most likely to have had Covid-19. The National Institute for Communicable Diseases surveillance and wastewater surveillance data also confirms that other respiratory viruses remain at low levels at the moment.”

What should I know about the respiratory virus outbreak in China?

In recent days, there has been a flurry of international media attention around the rise in human metapneumovirus (hMPV) cases in China, with the combination of keywords like “virus”, “surge” and “China” causing alarm in some circles. However, recent updates from the World Health Organization (WHO) suggest that an uptick in hMPV cases in the northern hemisphere is not unusual for this time of year.

Human metapneumovirus, a respiratory virus first identified in 2001, has been circulating for decades. It’s closely related to respiratory syncytial virus and primarily causes upper and lower respiratory tract infections, according to the National Institute for Communicable Diseases.

In a statement released on 7 January, the WHO said, “In many countries of the northern hemisphere, trends in acute respiratory infections increase at this time of year. These increases are typically caused by seasonal epidemics of respiratory pathogens such as seasonal influenza, respiratory syncytial virus, and other common respiratory viruses, including human metapneumovirus (hMPV), as well as mycoplasma pneumoniae.

“Based on data published by China, covering the period up to 29 December 2024, acute respiratory infections have increased during recent weeks and detections of seasonal influenza, rhinovirus, respiratory syncytial virus, and hMPV, particularly in northern provinces of China, have also increased. The observed increase in respiratory pathogen detections is within the range expected for this time of year during the northern hemisphere winter.”

Influenza was currently the most commonly detected respiratory pathogen affecting people with acute respiratory infections in China, continued the WHO.

“WHO is in contact with Chinese health officials and has not received any reports of unusual outbreak patterns. Chinese authorities report that the healthcare system is not overwhelmed and there have been no emergency declarations or responses triggered. WHO continues to monitor respiratory illnesses at global, regional and country levels through collaborative surveillance systems,” it said.

What does the outbreak in China mean for SA?

The National Institute for Communicable Diseases has stated that the risk of importing respiratory illnesses from China is low, based on a risk assessment tool for South Africa.

“South Africa’s robust syndromic respiratory illness surveillance system, run by the Centre for Respiratory Diseases and Meningitis at the National Institute for Communicable Disease, will continue to monitor the local data for any changes in disease patterns while being on the alert for anything unusual through the Outbreak Response Unit’s event-based surveillance, including media monitoring,” said the institute.

The national Department of Health was “closely monitoring” the situation in China, according to Mohale. He noted that any outbreak of disease or surge in cases should be a concern for other countries because “we live in a global village and diseases have no boundaries”, but added that there was no need for the public to panic.

“Learning from Covid-19 response, the country has developed a National Respiratory Pathogen Pandemic Preparedness Plan as part of the country’s ongoing efforts to prepare for future respiratory pathogen pandemics,” said Mohale.

“We urge people to always observe personal hygiene practices to protect themselves and their loved ones against many preventable and manageable diseases and viruses. People are urged to continue hand washing, and covering their nose and mouth when they cough and sneeze.”

Suliman told Daily Maverick that while he was not familiar with hMPV, other medical experts had indicated that there was no cause for concern about the virus in South Africa.

“It is not a new virus and has been circulating in South Africa for many years, as one of the normal seasonal respiratory viruses. Therefore, we should already have levels of immunity against this virus and should not expect any large outbreaks,” he said.

What are the symptoms and treatment options for hMPV?

Human metapneumovirus is primarily transmitted through respiratory droplets from coughs or sneezes and close physical contact, though it can also be spread by coming into close contact with contaminated objects or surfaces, according to the National Institute for Communicable Diseases.

Common symptoms include mild upper respiratory tract (cold-like) symptoms, such as:

A cough.

Runny nose.

Nasal congestion.

Fever.

A sore throat.

“In severe cases, especially in high-risk groups, hMPV can cause bronchitis, bronchiolitis or pneumonia, leading to difficulty breathing. The typical incubation period is three to six days, and with mild illness; the symptoms should improve after three to five days, but the duration of the illness can vary based on the severity,” said the National Institute for Communicable Diseases.

There is no vaccine for hMPV at this time, though vaccines for the disease are in development, along with a combination vaccine for hMPV and RSV (respiratory syncytial virus). Most cases of hMPV are mild and can be treated at home with rest and hydration. In more severe cases, people should seek care at a clinic or general practitioner. DM

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